Blog | Friday, November 18, 2011

Patients need teamwork in medicine


Atul Gawande, MD, says that we're used to doctors working like "cowboys," rugged individualists who are responsible for making sure your care gets done right. We don't need cowboys, he says. We need "pit crews," teams of doctors working together toward a common goal, with each playing their own role.

It's an appealing idea. Pit crew-like teams work, and work well, in trauma units across the country.

But there's a problem: if you haven't just been airlifted to a hospital after a horrible accident, you're not going to be treated by a pit crew. You're going to be on your own, shuffled from one 15-minute specialist visit to the next, likely with no one person in charge of your care.

Dr. Gawande knows this, and he picks a heck of an example of the problem:

"But you can't hold all the information in your head any longer, and you can't master all the skills. No one person can work up a patient's back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don't even know what it means to 'protocol' the MRI."

Why is that such a good example? Because it's exactly what happened to my brother at one of the leading medical centers in the country. He had a person directing the work up of his back pain and all the rest, including deciding on the right treatment for the "unexpected cancer found growing in his spine." It all worked well ... except that he didn't have cancer at all. In fact, had he been treated for cancer, he might not be with us today.

The truth is when you get sick, there is no pit crew rushing out to help you make your way through the system. There are overburdened, time-pressed doctors making decisions based on fragmented and often incomplete information. Scientific studies showing diagnoses are inaccurate more than 20% of the time are a clear warning sign and a symptom of this public health crisis.

If you're sick, you don't have time for the system to change. And so while we may not want our doctors to be cowboys, as a patient, you better learn how to be one. Be self-reliant, demand answers, and, above all, know this: the person with the greatest stake in getting your care right isn't your doctor, it's you.

This post by Evan Falchuk, JD, appeared at Get Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.